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In reading all the above comments, there are a few things that I found interesting. I wanted to briefly touch on the whole placebo thing-- simply because its gotten so much press above. I think that money is one of the biggest issues for me; otherwise, I'm really pretty okay with doing what Professor Grobstein said and prescribing something that "has been shown to work in 60% of the cases" even if it has been shown to work because of the placebo effect. I think that this whole concept of "placebo" is a little skewed, as has been mentioned above, because if it is indeed doing something then its working and therefore not a placebo as we would generally define it. I think we need to take a second to realize exactly how little we really know about the brain, and the mechanisms of action that a placebo might take. I sort of like to compare a placebo to CBT (hang on, before all you CBT supporters cut the idea down): I think that a placebo allows the brain to in a way 'confront itself.' Because the brain thinks its healing, it actually IS healing-- our brain is an incredibly powerful tool in its own ability to change its health/state. However, to go back to my original point, the issue of cost becomes a problem for me. I feel that a placebo effect will diminish if people don't feel like they have to pay too much for it (since i think payment and drugs are intimately linked in our cultural perception of diagnosis/treatment), but I can't rightfully charge people a lot for a sugar pill. dilemma...

to switch to another topic, the other thing that i want to stress, which was talked about a bit, is this idae that pain in the brain without a bodily source is just as important. We simply do not know enough about the brain to decide what pain merits diagnosis and what is "phantom"-- and why is phantom perceived as less important when it is an actually phenomenon? Since we saw a Grey's anatomy clip in class (man sawing his own foot off), the other side of the story is a different grey's anatomy episode where a drug addict manages to convince everyone of his back pain and get some serious pain killers. I think this is a big source of the dilemma over treating pain that cannot be "diagnosed"- the person might be lying to us. Yes, I admit this is a big problem and I can't really think of a good solution to it... but I think that, much like all mental states, pain is an interpretable thing and is different for everyone. Liz and I were talking in class about how, for a pain study that she had to run, some people found a hot pad against the arm much more painful than an ice bath... and visa versa. I think we need to realize that there is a spectrum for pretty much all mental experience and try to treat and diagnose accordingly.